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Posts Tagged ‘ACO’

Accountable Care Organizations (ACOs) as a model to deliver high-quality, cost-effective care across the continuum and improve population health management (PHM) has significantly increased. In an ACO, healthcare providers take responsibility for the health of a defined population, coordinate care across the continuum, and are held to benchmark levels of quality and cost. In 2015 ACOs will continue to be on the rise! Read the rest of this post »

“The Wizard of Oz” is a wonderful movie, full of metaphors that can be applied to real life. As I look at the current state of Healthcare, I can’t help but wonder if there is a true “yellow brick road” from volume based care to value based care. If there is, which stops will we make along the way and what roadblocks will we face?

Physician engagement is a crucial component on the road to value-based care. As Michael Porter and Thomas Lee mentioned in their article in the Harvard Business Review, “care fragmentation is reinforced by the fee-for-service model in which each doctor, specialist or otherwise, is paid separately, while the hospital receives its own payment.” They go on to mention that crucial services, like care coordination, are often not reimbursed, thus further fragmenting healthcare.

As our population ages, these crucial components will need to be addressed as practices, hospitals and payers will be flooded with patients needing coordinated services. So how do we engage our physicians in this battle? Like the Scarecrow, listening and learning needs to take place. We can allow clinicians to work to the level of their licenses to unburden the physicians by coordinating patient care and documentation which becomes available for the treating physician. This will then allow the physician to spend quality time diagnosing and treating the patient, patient and physician satisfaction will rise and overall medical costs will decrease. Payers, Accountable Care organizations (ACO’s), Patient Centered Medical Homes (PCMH) and governmental regulators will see the health care value being generated. With value-based care, these services should be included in reimbursement and quality care should be rewarded. Sounds simple, right?! Read the rest of this post »

Medicare is basing hospital reimbursements on performance measures. Patient satisfaction determines 30% of the incentive payments, and improved clinical outcomes decide 70 percent (source). So, it is no surprise that the term “patient experience” is rolling off people’s tongues very matter-of-fact like.

With the focus primarily on the hospital or inpatient setting, it’s easy to forget about the ambulatory or outpatient setting when it comes to patient experience. However, as the country continues to shift its efforts to preventing medical problems rather than simply fixing them, the spotlight is moving to the outpatient setting. Therefore, it is equally, if not more important for those in the medical practices to take the necessary steps to assure their patients’ experiences are top notch in this new care delivery model.

Positive Outcomes and Opportunities

The benefits to improving patient experience are plentiful, regardless of the care setting. However, the Language of Caring has done a great job highlighting and explaining specific areas within the outpatient setting where increasing quality patient experience can bring about positive contributions and opportunities. Here are the exact details they provide:

Improved outcomes and healthier patients – Improved quality patient experience in medical office settings brings about optimal health outcomes. Patients are less anxious in their visits and communications with the physician and care team. The physician and other staff are more successful eliciting needed information from patients and engaging them in decisions that affect their health. Because of greater trust, they are more likely to relax and cooperate during procedures, take their medicine, adhere to their care plans and follow-up with their care, improving care outcomes.

Patient retention, loyalty, and growth- By providing consistently satisfying patient experiences, medical practices and other ambulatory care centers win patient loyalty and become a provider of choice. Patients spread the word, which brings in even more patients. As people engage in provider-shopping, services that provide a quality patient experience attract new patients via positive word-of-mouth from their current patients. Also, provider scorecard initiatives are proliferating to assist purchasers in their buying decisions. Providing a quality patient experience is a powerful growth strategy. Read the rest of this post »

HIE, clinical data, quality measures, financial and claims data along with healthcare analytics – what does it take to decrease readmission rates in nursing homes?

There is so much attention these days on making the most of all of the clinical and financial data regarding healthcare, hospital readmission costs and reimbursement, but do we really know what changes can or will make a difference?

It has been a long time since I have done bedside nursing, but I can remember how often I would have one or more patients assigned to me who had come from a skilled nursing facility, long-term care facility or “nursing home.”

According to the recent Office of Inspector General (OIG), Medicare Nursing Home Resident Hospitalization Rates Merit Additional Monitoring report, in Fiscal Year 2011, one quarter (24.8%) of Medicare residents in nursing homes were transferred to hospitals for inpatient admissions, at a cost of $14.3 billion for the hospitalizations. The hospitalizations were required for a wide range of conditions with septicemia the most common. While the majority (67.8%) were transferred to hospitals only once, 20% transferred two times, 7.2% transferred three times, and the remaining 5% transferred four or more times. Of the Medicare costs for hospitalizations in FY2011, care for a nursing home resident cost an average of $11,255 per hospitalization, which is 33.2% higher than the average Medicare hospitalization ($8,447). Read the rest of this post »

I just finished watching a quick slideshow on the Health Data Management website, “Enterprise Analytics: Moving on Up” and as luck would have it, I also watched several sessions of the live Webcast from the Healthcare Innovation Day Conference 2014 in Washington, DC, sponsored by West Health Institute and the Office of the National Coordinator for Health Information Technology (ONC).

While I was watching these, I was intrigued by the thought of how Accountable Care Organizations (ACO) can leverage existing solutions, combined with point solutions, to accomplish their reporting, analytics and beyond, and use interoperability wisely. One of the key learning points for me from these sessions was this: “Reframe the problem”….advice from Malcolm Gladwell’s keynote address.

How do we “reframe the problem” when it comes to ACO reporting and analytics? There are defined metrics that are required for these organizations, so how can we leverage existing systems to create these reports and analytics? Do we “build vs. buy”? Depending upon the organizational size, legacy systems and IT support, the decision can be difficult. What is good for one system may not work in another. So where do we start?

A strategic evaluation of current state and desired future state with the development of a road map may be a logical first step. Data Governance also needs to happen early on in the process to allow an organization to create data standards that will drive reporting and analytics. Once these steps have occurred, an organization can feel confident that they can make an informed decision to “build or buy.”

The patient centered medical home (PCMH) emphasizes care coordination and communication between various healthcare delivery systems. This coordinated care system can lead to better quality healthcare delivery as well as a better patient experience – but in order to achieve these benefits, providers must be able to see and interpret data from across the many entities the patient interacts with.

Join us October 29th for the webinar “Make the Most of Your ACO with Healthcare Analytics.” You will learn how Oracle Enterprise Health Analytics (EHA), coupled with Oracle Business Intelligence and Oracle WebCenter, fulfills the ACO mandate for a patient centered medical home.

The healthcare IT field is rapidly developing and changing. Emerging technology and updated regulations put pressure on healthcare providers and health plans to stay ahead of the curve. Perficient creates a monthly list that explores some of the current topics and issues in health IT. This list examines the most talked about issues and technologies that are currently affecting the industry.

Accountable Care Organizations: First Year Results

An ACO is a group of healthcare providers that partner under a payment and delivery reform model that become collectively accountable for the full continuum of care for a population of patients. This reform model ultimately ties reimbursement to quality metrics and reductions in the total cost of care for the patient population. First year results for ACOs were recently released, with very mixed success and several hospitals dropping out of the program.

The Quantified Self

With the progression of patient engagement, consumers are looking to become involved in their own care and health. The quantified self movement helps patients track their health, physical activity, food consumption, heart rate, and more. From mobile apps to worn digital sensors like the FitBit to implanted devices, patients keep track of their own health data – which eventually may be used to create a more personalized experience.

The healthcare IT field is rapidly developing and changing. Emerging technology and updated regulations put pressure on healthcare providers and health plans to stay ahead of the curve. Perficient creates a monthly list that explores some of the current topics and issues in health IT. This list examines the most talked about issues and technologies that are currently affecting the industry.

ACOs and Patient Centered Medical Homes

An ACO is a group of healthcare providers that partner under a payment and delivery reform model that become collectively accountable for the full continuum of care for a population of patients. This reform model ultimately ties reimbursement to quality metrics and reductions in the total cost of care for the patient population. Patient Centered Medical Homes (PCMH) focus on improving the quality of care delivered by creating a health care environment that facilitates communication between the patient and their physician, allowing patients to receive and understand the care they need when they need it.

Telehealth and Remote Patient Monitoring

The healthcare industry is experiencing revolutionary changes stemming from the rapidly shifting role of the patient within the continuum of care. This is resulting in high demand for easier access to healthcare professionals, access to online medical information, and alternatives to traditional care. Telehealth allows for the transmission of medical images, video, audio and information related to diagnosis and treatment can be stored and sent from the provider’s computer or mobile device via secure data exchanges. Remote Patient Monitoring allows patient’s health data to be sent electronically to a provider who then can analyze it and respond with appropriate recommendations.

These insights lead to smarter decisions, and that ultimately leads to better outcomes for patients.

For an organization to be successful as an Accountable Care Organization (ACO), it must be defining and leading communities of care by going beyond just information share, and toward co-creating the next generation healthcare industry.

I think Premier healthcare alliance is working toward making this next generation healthcare industry a reality.

And here’s why.

InformationWeekpublished a story yesterday on big data and analytics in healthcare. In the story, they highlight a new collaborative of healthcare organizations that was created by Premier health alliance. Called the Data Alliance Collaborative (DAC), it enables these organizations to learn from one another as they develop population health management tools.

IBM hardware and software aggregates member data while Premier, working with IBM and with our healthcare team, developed an integrated payer and provider data model on which DAC members are building these population health management applications.

Imagine this:

Clinical, financial and claims data, from multiple care systems, coming together in one place to produce insights and trigger alerts and reports that allow providers to improve care for individuals.

The DAC is working on building tools that will:

Quickly notify providers about patients who haven’t filled a prescription within 24 hours. This should help them to improve transitions of care.

Analyze electronic health records and administrative data to find patients more likely to be readmitted before they’re discharged. This will take into account risk factors that often lead to readmissions using an evidence-based checklist by medical condition. They call this an “all-cause predictive readmissions model.”

“One leading system integrator is creating assets for this group that will later be commercialized if somebody consumes them.” That integrator is Perficient.

We are so proud to be a part of this, and we look forward to talking more about what these tools look like and how they’re improving care and working to improve population health management for healthcare organizations across the country!

I was recently talking with one of my colleagues about a strange situation that happened to her when her local hospital and healthcare provider merged with a larger healthcare system. As a result of the merger, she no longer had a local healthcare provider in her town that took her insurance plan. In essence, she was a victim of healthcare merger mania and had to find a new healthcare insurance plan for coverage. Healthcare organization mergers are part of a broad national trend that is driven by accountable care and the tremendous pressure to cut costs, improve productivity and improve outcomes.

As a result of this merger trend, medical care is being concentrated in fewer institutions, and concern about the impact on higher prices is increasing. A hospital merger boom in the 1990s increased patient costs by 5 to 40 percent in areas where only a few hospitals dominate, according to the Robert Wood Johnson Foundation. Large healthcare organizations with multiple hospitals tend to charge higher prices in communities where they outnumber their rivals, says health economist James C. Robinson of the University of California, Berkeley. This information contradicts the usual arguments for accountable care that merging or affiliating with generate greater efficiencies, higher quality of care and increased savings. More than 100 hospital merger deals took place in 2012, double the number of only three years earlier. Here is the scary statistic: Of the 5,724 hospitals in the United States, about 1,000 will have new owners in the next seven years or so, according to Gary Ahlquist, a senior partner with the consulting firm Booz & Company.

The healthcare IT field is rapidly developing and changing. Emerging technology and updated regulations put pressure on healthcare providers and health plans to stay ahead of the curve. Perficient creates a monthly list that explores some of the current topics and issues in health IT. This list examines the most talked about issues and technologies that are currently affecting the industry.

Patient Engagement and e-Patients

The term “patient engagement” is on the tip of the healthcare industry’s tongue these days. We can only end the long-running trend of low patient engagement, along with the dangerously high cost of care, by shifting to true patient engagement that holds the patient experience, and the power of the resulting data, at forefront of healthcare business strategy. The healthcare industry is shifting emphasis to the patient, caused not only by government mandates but also by a shift in consumer expectations inspired by other industries that have permeated healthcare.

Healthcare Payment Reform

It is a common opinion that our healthcare system does not provide good value for the care received. Incentives for hospitals are not properly matched with delivering the best possible care at an affordable rate. In response, healthcare payment reform models have been created. Bundled payments reimburse healthcare providers based on the expected cost of a group of services delivered, instead of payment for each treatment provided. Hospital value based purchasing tie reimbursement to the quality of care delivered based on clinical results and patient satisfaction.

In the healthcare technology space, we are all working toward the same general end goals of improving patient care while lowering costs. Healthcare organizations are all looking for ways to more broadly use technology that not only focuses on each encounter, but looks beyond that toward the continuum of care for the individual and the population.

At Perficient, our thought leaders and strategic consultants are responding to these demands by putting together solutions that will arm providers with the clinical and financial analytical data they need in order to:

Share information across and between organizations and care providers

Derive key insights from that data

Deliver on best practices in care quality based upon insights from that data

Meaningfully measure their own performance along the spectrum of quality of care

Analyze, benchmark, and understand what that performance means, and where opportunities exist

Stay on top of shifts in regulatory policy

and much more…

Today, we are thrilled to announce that we have partnered with Premier Healthcare Alliance to develop data collection and reporting applications on their PremierConnect platform, which is the largest integrated technology and social business platform in healthcare. Read the rest of this post »